Anti-Aging Clinics Proliferate in Florida

The Boca Raton, Fla., clinic is now shut down, its principals charged last month with selling the drugs illegally. But the business of selling hormones claiming they build hard muscle, burn flab and reverse the effects of aging has been a lucrative _ and controversial _ staple for years in South Florida.

Dozens of clinics make millions yearly selling hormones, often venturing into gray areas of medicine and the law, prosecutors and physicians say. Among the sellers are a former cocaine dealer and a former merchant of illegal steroids.

"It's a huge business because people want the fountain of youth," said Dr. Paul Jellinger, an advisor to the American Association of Clinical Endocrinologists. "They're just disregarding the fact that there's no proof that it works. (Also,) this stuff can hurt you."

Two sets of arrests this year showed the underside of the business.

In February, 14 people running seven Internet pharmacies in South Florida were indicted by a federal grand jury, accused of selling drugs without the patients visiting a doctor. In Florida and many states, it's illegal to prescribe or sell a drug unless the doctor first sees the patient in person.

Then, last month, officials from Albany, N.Y., arrested 15 people, including eight in South Florida, suspected of selling hormones and steroids to buyers _ a few of them pro athletes _ without a doctor visit. The ring centered on Signature Pharmacy in Orlando, which was charged in the case and sold $40 million of the drugs last year, said Christopher Baynes, an assistant district attorney in Albany.

Signature's top source of customers: Palm Beach Rejuvenation Center, an anti-aging clinic in Palm Beach Gardens that accounted for $15 million of the business, said Baynes. Officials arrested two of the clinic owners and its doctor, plus six others at Oasis and online site medxlife.com, which each accounted for millions of the revenue.

The principals at Signature and the clinics have pleaded not guilty and declined to comment.

Signature sold to at least two dozen South Florida clinics. Said Baynes: "There are more out there involved with Signature. I don't know whether more will be charged."

Among the names to surface in connection to the case:

Palm Beach Life Extension in Palm Beach Gardens. An Albany agent said in a document the clinic is separate but "under the control" of Palm Beach Rejuvenation and sold drugs illegally.

The Health and Rejuvenation Center in Palm Beach Gardens. At least one co-owner used to work at Palm Beach Rejuvenation, attorneys and other clinic operators said.

Infinity Rejuvenation in Deerfield Beach. A doctor was arrested in Albany on charges she signed illegal prescriptions from the clinic.

Metragen Pharmaceuticals in Deerfield Beach. In documents, Albany agents said some of Signature's illegal prescriptions came from Metragen. The company's founding principal started it after his former pharmacy, Powermedica, was shut down in 2005 for illegally selling steroids.

The owners of those four businesses have not been charged. Officials or attorneys for the four declined to comment or could not be reached with calls to their offices.

Hormone sellers said Signature was the biggest single supplier in South Florida and aggressively recruited clinics that sent them the customers.

"Signature solicited everyone, from the small sites to the big sites to the individual doctors," said Mark White, director at Anti-Aging Group Health in Aventura who said he did not use Signature.

In affidavits, agents said clinics in the Albany case used Web sites and ads to attract patients who filled out medical forms and got blood tests, but never saw a doctor. A clinic doctor wrote a prescription, which was filled by Signature and shipped to the patient.

The Oasis marketing director, Aaron J. Peterson, told a judge when he pleaded guilty March 28 that the clinic paid Signature $10,000 for finding a doctor who signed prescriptions without seeing patients.

Owners of another South Florida clinic also paid Signature to line up a doctor, and paid the doctor thousands per month for signing prescriptions, said the clinic's attorney, John Contini. He spoke on the condition his clients not be named.

"These physicians were abdicating their duty to the patient," Contini said.

Contini said Signature also sent his clients to an attorney who, for $1,500, assured them the operation was legal.

South Florida "anti-aging" clinics have been selling human growth hormones, or HGH, since the 1990s. The owners grasped onto a few small studies suggesting that symptoms of aging declined after shots of HGH, which is made by the pituitary gland to control metabolism.

"It's hormone replacement therapy, to make people feel better," said Jeffrey George, owner of South Beach Rejuvenation in West Palm Beach. "Females have menopause and no one complains about them getting hormones. Men have `andropause' and we prescribe hormones for them."

The cost: Up to $1,000 a month.

Specialists and federal officials say it's medically correct to use HGH for patients who no longer produce it, which normally is caused by trauma or pituitary tumors. But there's no proof shots help when HGH declines naturally, experts said.

"Hormone levels go down as we get older. That's somehow how nature figured out how to do it," said Dr. Michael Karl, a specialist at the University of Miami medical school.

What's more, doctors said studies show that having too much HGH for one's age can cause heart disease, high blood pressure, diabetes and muscle and joint pain, and possibly spur cancer cells.

Some HGH proponents contend that most older patients need shots because they have low levels in their blood. But physician experts said a low level means little because HGH fluctuates and drops near zero daily. Albany prosecutor Baynes said clinics in his case sold HGH to patients with normal test results.

Brian Cotugno, who used to be a consultant to HGH clinics, said many would not stop selling to patients with normal lab tests because they would lose millions in sales to those using it for non-medical reasons.

"A lot of their business was (from customers) who just wanted to call and order substances over the phone," Cotugno said.

Cotugno said he got into the business a few years ago, after a 10-year sentence for cocaine trafficking, which he called a mistake at age 22. He started his own clinic, Maxim Rejuvenation in West Palm Beach, Fla.

Maxim was one of eight entities dropped last month from a list of approved online pharmacies by the accreditation group Pharmacy Checker, said its vice president, Gabriel Levitt.

After the Albany arrests, the nonprofit group no longer accredits online pharmacies that sell or promote HGH, he said.

Testosterone: An anabolic steroid, the male sex hormone promotes tissue growth. Doctors prescribe it when the body fails to make it. No large-scale research shows whether it can combat age-related changes. Excess amounts can cause sterility, spur prostate cancer and worsen sleep apnea.

Hormone pills, sprays: Some sellers offer HGH as a pill or an oral or nasal spray instead of as an injection. Less is known about the possible benefits compared with injectable HGH.

Natural supplements: Some sellers promote nonprescription protein supplements, amino acids and other substances they contend will spark the body to produce more hormones. No one regulates these, and there's little data whether they work or are harmful.

'Age management' is a controversial new medical focus

Story Highlights

• Age management a fast-growing, controversial trend in American medicine• American Medical Association does not recognize the field as a specialty• U.S. anti-aging products market worth $45.5 billion annually and growing

CNN's Dr. Sanjay Gupta reveals discoveries from around the world that can add years to your life in Chasing Life, Saturday-Sunday April 14-15, 8 p.m. ET

By Caleb HellermanCNN

Visit CNN.com/Health in coming days to read more on dietary supplements and human growth hormone.

ATLANTA, Georgia (CNN) -- Clothia Roussell draws inspiration from the prophets. "I've read in the Bible how we're supposed to live to see 120, and those prophets lived to be 400 or 500 years old," said the 49-year-old homemaker.

"My husband and I, we're both looking forward to living a long, healthy life," she said. Last fall, Roussell and her husband Michael, 47, who owns a commercial construction business in Fayetteville, Georgia, began seeing Dr. Ana xxxx, who calls herself a specialist in "age management." It's one of the fastest-growing trends in American medicine.

The Business Communications Company Research firm says the U.S. market for anti-aging products is worth $45.5 billion and growing nearly 10 percent a year.

On its Web site, xxx refers to "the arcane, outmoded stance that aging is natural and inevitable" and says "the disablities associated with normal aging are caused by physiological dysfunction." That attitude is controversial.

The American Medical Association does not consider anti-aging an official specialty. Unlike Casas, who is board-certified in internal medicine and was an assistant professor at Dartmouth Medical School, many anti-aging practitioners are not certified in traditional fields. xxx

Some observers say the whole field is an expensive hoax. "There is no such thing as anti-aging medicine," huffs Jay Olshansky, a sociologist at the University of Illinois who studies medicine and longevity. "As long as humans have existed, we have always desired to live longer. Every society, every religion, every culture. Of course, they all failed at dramatic life extension." Olshansky was slapped with a $120 million dollar defamation lawsuit by A4M after he accused the organization of promoting quackery. He countersued and both sides eventually agreed to drop their cases.

After meeting Dr. xx, the Roussells started taking more than three dozen dietary supplements and began a serious diet based mostly on "good" carbohydrates and small helpings of fish, nuts, fruits and legumes. They also received an "exercise prescription" from xxx' business partner Lee Haney, an eight-time Mr. Olympia.

Casas' patients don't waste time in waiting rooms. She not only shares her cell phone number with them, but sits down every afternoon to answer e-mails. A medical technician makes house calls every three months to collect blood samples. The personalized attention isn't cheap. An initial consultation costs $2,250 and patients pay $995 every six months for unlimited consultations. Add anywhere from $200 to $500 a month for blood work and supplements, and it gets pricey. Most costs are not covered by insurance.

Another patient is John Smith, a blunt-talking former Marine. Smith says he considers most doctors to be "quacks," but praises Casas' boundless willingness to answer questions. "Our first meeting was scheduled for three hours, and we ended up talking for four and a half hours," says Smith, 64. "So many doctors are so rushed that you don't get any feeling of getting real attention. They throw you a pill, and run."

Casas herself is a refugee from what she disparagingly calls insurance-based medicine. "Your typical internist may have 4,000 patients. I've decided to limit myself to 400," she says. "Before, I would see a patient for maybe 10 minutes at a time. Now, I usually know as much about them as they know about themselves."

It's true that some anti-aging therapies fly in the face of traditional advice. Some doctors talk of measuring a physiological age -- as opposed to a chronological age -- even though the concept is dubious. "The only way I can tell your age is by looking at your birth certificate," says Dr. Nir Barzilai, director of the Institute of Aging at Albert Einstein Medical School in the Bronx. "There is no test I can give you which will tell me, with any precision, exactly how old you are." Besides that, many patients take dozens of supplements, even though published studies have found few benefits. And then there's the aggressive use of hormone therapy. Many anti-aging doctors use a liberal definition of "hormone deficiency" in order to prescribe human growth hormone, which mainstream physicians say should generally be reserved for children with growth problems.

Dr. Casas, who says she prescribes growth hormone for only a handful of patients, says the focus should be on more mainstream aspects of the practice. "Age management is preventive medicine," says Casas. "You want to live as long as you can, with the highest quality of life possible."

Clothia Roussell said the effects of the program were apparent right away. "It was not subtle. My son came to visit and said, 'wow, Mom, you're getting younger.' "We'll be seeing Dr. Casas for the next 75 years," she added with a gleaming smile. Why settle for less? A growing number of patients, at least those who can afford it, can't think of any reason not to.

Caleb Hellerman is a producer with CNN Medical News.

Defy Another Day

NEW YORK TIMESBy NATASHA SINGER

Published: April 17, 2007

I can’t understand the term “anti-aging.”

Tony Cenicola

Ditto for its equally baffling synonyms: “age-defying,” “age-reversing,” “age-perfecting,” “age-deflecting” and “de-aging” (a neologism that suggests the patina of time can be sprayed off with the same stuff used to de-ice airplanes).

It’s not that I’m linguistically challenged. I can easily parse “anti-wrinkle” and “anti-cellulite”: furrows and dimples are visible, concrete attributes. For those who view them as the skin equivalent of senescence, be my guest: rage, rage against the appearance of cellulite.

But to be “anti-aging” seems about as logical as being “anti-Tuesday” or “anti-weather.” Like them or not, Tuesdays and rain will come. As will skin aging, even though a number of face creams position themselves as time machines, promising to stop the biological clock, rewind the hours of sun exposure or even, as one recent ad campaign put it, “get 10 years back.”

A nonsense word, and yet it’s everywhere: the inevitable Google search turned up three million references. (Anyone for Natural Anti-Aging Butter Premium Grade A Shea Butter?)

How did such an oblique term so entrench itself in our everyday vocabulary? As far back as the ancients, humans have searched for immortality and have employed words that connote longevity, said Erin McKean, the chief consulting editor of the American Dictionaries published by Oxford University Press. “We’ve been using ‘rejuvenate,’ meaning to restore youth, to make young again, as a verb for at least 200 years,” she said. “Anti-aging,” however, is a relative newcomer. “ ‘Anti’ means something we don’t like. ‘Aging’ has been bad ever since we figured out it led to dying.”

Though the term has been used for decades, it became popular in the late ’80s; McKean found a 1984 article on “anti-aging” in The Washington Post describing an investigation into medical quackery. Conducted by the Senate Special Committee on Aging, the investigation found arthritis cures made of “moon dust,” ground diamonds being sold as cancer medicines, “and anti-aging serums containing placenta extracts, amino acids or other worthless chemicals.”

About that time, “anti-aging” started showing up in the names of cosmetics and other products. McKean theorized that the term caught on because it’s so amorphous, allowing for vague-sounding product claims. “If you say ‘anti-aging,’ how anti would it have to be, really?” she asked. “My guess is not much. Any amount of sunscreen could be considered anti-aging.”

It’s not that there’s anything wrong with aging interventions. After all, anyone who takes cholesterol medicine is not aging naturally. But buying into anti-aging products seems to say something deeper about our collective bid for immortality through technology — or at least an immortal exterior. It doesn’t seem to matter if the products have a physical effect as long as they have an emotional one. Like alchemy, they posit the idea that we can engage against time.

And that’s the thing. “Anti-aging” can connote many things — death-defying, youth-prolonging, appearance-enhancing — but underneath, our obsession with the term is really just a symptom of our contemporary malaise: age-phobia.

“Anti-aging” means to this generation what “anti-war” meant in the ’60s, said Nina Jablonski, the head of the anthropology department at Pennsylvania State University. It’s a kind of collective term for our fears and dislikes, she said. “ ‘Anti-aging’ is one of the words that has slipped into the language in this decade because everything connected to natural aging is anathema,” said Jablonski, the author of “Skin: A Natural History.” “It doesn’t matter if it’s anti-aging breakfast cereal or bath salts or a particular flavored water that one drinks at the gym. Anti-aging is equated with not being old, and especially not looking it.”

We’ve experienced the war on drugs, the war on crime, the war against AIDS and the war on terror. Now we are witnessing the war on aging. Once a fact of life, aging is emerging as a malady to be fought with the same vigor as, say, cancer. The International Congress on Anti-Aging Medicine and Regenerative Biomedical Technologies, which first met in 1993 with 12 physicians, expects more than 3,000 attendees this month.

Perhaps the biggest downside to the anti-aging mania might be felt by those who do not wish to participate in it, making people who busy themselves with occupations other than the Sisyphean fight against wrinkles and bulges feel like they lie outside the popular norm.

Allen Ginsberg, ever the gadfly of the human condition, once referred to himself in an early verse as “this clock of meat.” He was 23.

Now, almost 60 years later, some analysts are setting the decline of human attractiveness at an even younger age. At the annual meeting of the American Academy of Dermatology, Dr. Eva Ritvo, the vice chairman of the department of psychiatry at the University of Miami’s medical school, told a room of cosmetic doctors that age 14 is when a girl’s lips reach their peak of fullness. After that, she said, “it’s an uphill battle.”

As for this clock of meat, it’s enough to make me anti-anti-aging.

Fountain of Youth" Purveyor Fined

Two operations that marketed oral sprays that were supposed to help users lose weight, reverse the aging process, and prevent or treat diseases have settled Federal Trade Commission charges that their claims were bogus.

The FTC alleged that these businesses falsely claimed the sprays were a “fountain of youth,” containing or causing the body to produce human growth hormone (HGH). The FTC also accused one company and owner of sending illegal spam messages.

One group of defendants will pay $172,500 for consumer injury.

The defendants marketed their oral sprays on Web sites and in emails, making false claims, such as:

“LOSE WEIGHT WHILE YOU SLEEP without DIETING or EXERCISE”

“Experience up to an 82% IMPROVEMENT in body fat loss while erasing 10 YEARS in 10 WEEKS!”

The defendants claimed the sprays would counter symptoms of aging and prevent, treat, or cure diseases and medical conditions associated with aging. The marketing pitches for the sprays referred to clinical studies and prestigious publications to give credibility to their claims.

In fact, the FTC alleged that those claims were unproven and untrue. The FTC charged that the sprays did not contain HGH, or cause the body to increase production of HGH, and did not offer anti-aging, weight loss, or disease prevention effects.

Consumers bought the sprays from the defendants’ Web sites. The sites assured consumers that the sites were safe with the message:

NOTE: To ensure your personal privacy, all of the information that you submit to us after this point will be secured using SSL encryption technology.

However, the FTC charged that encryption technology was not used, making the credit card information submitted for payment vulnerable to capture while in transit.

Court orders against all of the defendants prohibit misrepresentations in marketing food, drugs, devices, services, or dietary supplements, including misrepresentations about the product benefits, misrepresentations about studies and research, and representations made without possessing competent and reliable scientific evidence. The orders also prohibit misrepresenting the security of Web site pages.

The order entered against John A. Brackett, Jr. and his company, Pacific Herbal Sciences, Inc., also prohibits violations of the CAN-SPAM Act. The FTC charged that much of these defendants’ e-mail violated the CAN-SPAM Act by falsely identifying the sender, using deceptive subject headings, failing to include a mechanism for consumers to decline to receive future emails from the sender, and not disclosing the sender’s physical postal address.

Some of the e-mails sampled from the FTC’s spam database included forgery of ftc.gov and uce.gov email addresses, making it appear the e-mails were coming from these legitimate sources.

The order also entered a $762,000 monetary judgment, suspended based on their financial disclosures. The order entered against Lei Lu and his companies, Natural Health Product, Inc. and New Star Marketing Group, Inc., requires them to pay $172,500 for consumer injury. The rest of their $2,218,261 monetary judgment is suspended, also based on their financial disclosures. For both monetary judgments, if it is found that the defendants lied about their financial status, then they will be liable for the full judgment amount.

A POSITION PAPER BY LEADING HEALTH SCIENTISTS ON THE ANTIAGING SCAMS

THE BELOW ARTICLE CAN BE FOUND IN THE JUNE ISSUE 2002 OF SCIENTIFIC AMERICAN

ABOUTARTICLE

Antiaging products are big business--a multibillion-dollar industry. But the marketing of these products often misrepresents the science. Rather than let their silence imply compliance, 51 of the top researchers in the field of aging research collaborated to create a position paper that sets out the current state of the science. A shorter, more pointed essay, called "No Truth to the Fountain of Youth," by three of the position paper's signers, S. Jay Olshansky, Leonard Hayflick and Bruce A. Carnes, is in Scientific American's June 2002 issue; the position paper itself is here. --The Editors Scientific American, June 2002.

POSITION STATEMENT OF 51 TOP SCIENTISTS ON FAD ANTIAGING PRODUCTS

In the past century a combination of successful public health campaigns, changes in living environments and advances in medicine have led to a dramatic increase in human life expectancy. Long lives experienced by unprecedented numbers of people in developed countries are a triumph of human ingenuity. This remarkable achievement has produced economic, political and societal changes that are both positive and negative. Although there is every reason to be optimistic that continuing progress in public health and the biomedical sciences will contribute to even longer and healthier lives in the future, a disturbing and potentially dangerous trend has also emerged in recent years. There has been a resurgence and proliferation of health care providers and entrepreneurs who are promoting antiaging products and lifestyle changes that they claim will slow, stop or reverse the processes of aging. Even though in most cases there is little or no scientific basis for these claims [1], the public is spending vast sums of money on these products and lifestyle changes, some of which may be harmful [2]. Scientists are unwittingly contributing to the proliferation of these pseudoscientific antiaging products by failing to participate in the public dialogue about the genuine science of aging research. The purpose of this document is to warn the public against the use of ineffective and potentially harmful antiaging interventions and to provide a brief but authoritative consensus statement from 51 internationally recognized scientists in the field about what we know and do not know about intervening in human aging. What follows is a list of issues related to aging that are prominent in both the lay and scientific literature, along with the consensus statements about these issues that grew out of debates and discussions among the 51 scientists associated with this paper.

Lifespan

Life span is defined as the observed age at death of an individual; maximum lifespan is the highest documented age at death for a species. From time to time we are told of a new highest documented age at death, as in the celebrated case of Madame Jeanne Calment of France who died at the age of 122 [3]. Although such an extreme age at death is exceedingly rare, the maximum life span of humans has continued to increase because world records for longevity can move in only one direction: higher. Despite this trend, however, it is almost certainly true that, at least since recorded history, people could have lived as long as those alive today if similar technologies, lifestyles and population sizes had been present. It is not people that have changed; it is the protected environments in which we live and the advances made in biomedical sciences and other human institutions that have permitted more people to attain, or more closely approach, their life-span potential [4] Longevity records are entertaining, but they have little relevance to our own lives because genetic, environmental and lifestyle diversity [5] guarantees that an overwhelming majority of the population will die long before attaining the age of the longest-lived individual.

Life Expectancy

Life expectancy in humans is the average number of years of life remaining for people of a given age, assuming that everyone will experience, for the remainder of their lives, the risk of death based on a current life table. For newborns in the U.S. today, life expectancy is about 77 years.6 Rapid declines in infant, child, maternal and late-life mortality during the 20th century led to an unprecedented 30-year increase in human life expectancy at birth from the 47 years that it was in developed countries in 1900. Repeating this feat during the lifetimes of people alive today is unlikely. Most of the prior advances in life expectancy at birth reflect dramatic declines in mortality risks in childhood and early adult life. Because the young can be saved only once and because these risks are now so close to zero, further improvements, even if they occurred, would have little effect on life expectancy [7-9]. Future gains in life expectancy will, therefore, require adding decades of life to people who have already survived seven decades or more. Even with precipitous declines in mortality at middle and older ages from those present today, life expectancy at birth is unlikely to exceed 90 years (males and females combined) in the 21st century without scientific advances that permit the modification of the fundamental processes of aging [10]. In fact, even eliminating all aging-related causes of death currently written on the death certificates of the elderly will not increase human life expectancy by more than 15 years. To exceed this limit, the underlying processes of aging that increase vulnerability to all the common causes of death will have to be modified.

Immortality

Eliminating all the aging-related [11] causes of death presently written on death certificates would still not make humans immortal [12]. Accidents, homicides, suicide and the biological processes of aging would continue to take their toll. The prospect of humans living forever is as unlikely today as it has always been, and discussions of such an impossible scenario have no place in a scientific discourse.

Geriatric Medicine versus Aging

Geriatric medicine is a critically important specialty in a world in which population aging is already a demographic reality in many countries and a future certainty in others. Past and anticipated advances in geriatric medicine will continue to save lives and help to manage the degenerative diseases associated with growing older [13,14], but these interventions only influence the manifestations of aging--not aging itself. The biomedical knowledge required to modify the processes of aging that lead to age-associated pathologies confronted by geriatricians does not currently exist. Until we better understand the aging processes and discover how to manipulate them, these intrinsic and currently immutable forces will continue to lead to increasing losses in physiological capacity and death even if age-associated diseases could be totally eliminated [15-20].

Antiaging Medicine

Advocates of what has become known as antiaging medicine claim that it is now possible to slow, stop or reverse aging through existing medical and scientific interventions [21-26]. Claims of this kind have been made for thousands of years [27], and they are as false today as they were in the past [28-31]. Preventive measures make up an important part of public health and geriatric medicine, and careful adherence to advice on nutrition, exercise and smoking can increase one’s chances of living a long and healthy life, even though lifestyle changes based on these precautions do not affect the processes of aging [32-33]. The more dramatic claims made by those who advocate antiaging medicine in the form of specific drugs, vitamin cocktails or esoteric hormone mixtures are, however, not supported by scientific evidence, and it is difficult to avoid the conclusion that these claims are intentionally false, misleading or exaggerated for commercial reasons [34]. The misleading marketing and the public acceptance of antiaging medicine is not only a waste of health dollars; it has also made it far more difficult to inform the public about legitimate scientific research on aging and disease [35]. Medical interventions for age-related diseases do result in an increase in life expectancy, but none have been proved to modify the underlying processes of aging. The use of cosmetics, cosmetic surgery, hair dyes and similar means for covering up manifestations of aging may be effective in masking age changes, but they do not slow, stop or reverse aging. At present there is no such thing as an antiaging intervention.

The scientifically respected free-radical theory of aging [36] serves as a basis for the prominent role that antioxidants have in the antiaging movement. The claim that ingesting supplements containing antioxidants can influence aging is often used to sell antiaging formulations. The logic used by their proponents reflects a misunderstanding of how cells detect and repair the damage caused by free radicals and the important role that free radicals play in normal physiological processes (such as the immune response and cell communication) [37-39]. Nevertheless, there is little doubt that ingesting fruits and vegetables (which contain antioxidants) can reduce the risk of having various age-associated diseases, such as cancer [40], heart disease [41,42], macular degeneration and cataracts [43,44]. At present there is relatively little evidence from human studies that supplements containing antioxidants lead to a reduction in either the risk of these conditions or the rate of aging, but there are a number of ongoing randomized trials that address the possible role of supplements in a range of age-related conditions [45-49], the results of which will be reported in the coming years. In the meantime, possible adverse effects of single-dose supplements, such as beta-carotene [50], caution against their indiscriminate use. As such, antioxidant supplements may have some health benefits for some people, but so far there is no scientific evidence to justify the claim that they have any effect on human aging [51-52].

Telomeres

Telomeres, the repeated sequence found at the ends of chromosomes, shorten in many normal human cells with increased cell divisions. Statistically, older people have shorter telomeres in their skin and blood cells than do younger people [53,54]. In the animal kingdom, though, long-lived species often have shorter telomeres than do short-lived species, indicating that telomere length probably does not determine life span [55-57]. Solid scientific evidence has shown that telomere length plays a role in determining cellular life span in normal human fibroblasts and some other normal cell types [588]. Increasing the number of times a cell can divide, however, may predispose cells to tumor formation [59-60]. Thus, although telomere shortening may play a role in limiting cellular life span, there is no evidence that telomere shortening plays a role in the determination of human longevity.

Hormones

A number of hormones, including growth hormone, testosterone, estrogen and progesterone, have been shown in clinical trials to improve some of the physiological changes associated with human aging [61,62]. Under the careful supervision of physicians, some hormone supplements can be beneficial to the health of some people. No hormone, however, has been proved to slow, stop or reverse aging. Instances of negative side effects associated with some of these products have already been observed, and recent animal studies suggest that the use of growth hormone could have a life-shortening effect [63-65]. Hormone supplements now being sold under the guise of antiaging medicine should not be used by anyone unless they are prescribed for approved medical uses.

Caloric Restriction

The widespread observation that caloric restriction will increase longevity must be tempered with the recognition that it has progressively less effect the later in life it is begun [66], as well as with the possibility that the control animals used in these studies feed more than wild animals, predisposing them to an earlier death. Although caloric restriction might extend the longevity of humans, because it does so in many other animal species [67-69], there is no study in humans that has proved that it will work. A few people have subjected themselves to a calorically restricted diet, which, in order to be effective, must approach levels that most people would find intolerable. The fact that so few people have attempted caloric restriction since the phenomenon was discovered more than 60 years ago suggests that for most people, quality of life seems to be preferred over quantity of life. The unknown mechanisms involved in the reduced risk of disease associated with caloric restriction are of great interest [71] and deserve further study because they could lead to treatments with pharmacological mimetics of caloric restriction that might postpone all age-related diseases simultaneously.

Determining Biological Age

Scientists believe that random damage that occurs within cells and among extracellular molecules are responsible for many of the age-related changes that are observed in organisms [72-74]. In addition, for organisms that reproduce sexually, including humans, each individual is genetically unique. As such, the rate of aging also varies from individual to individual [75]. Despite intensive study, scientists have not been able to discover reliable measures of the processes that contribute to aging [76]. For these reasons, any claim that a person’s biological or "real age" [77] can currently be measured, let alone modified, by any means must be regarded as entertainment, not science.

Are There Genes That Govern Aging Processes?

No genetic instructions are required to age animals, just as no instructions on how to age inanimate machines are included in their blueprints [79-80]. Molecular disorder occurs and accumulates within cells and their products because the energy required for maintenance and repair processes to maintain functional integrity for an indefinite time is unnecessary after reproductive success. Survival beyond the reproductive years and, in some cases, raising progeny to independence, is not favored by evolution because limited resources are better spent on strategies that enhance reproductive success to sexual maturity rather than longevity [81]. Although genes certainly influence longevity determination, the processes of aging are not genetically programmed. Overengineered systems and redundant physiological capacities are essential for surviving long enough to reproduce in environments that are invariably hostile to life. Because humans have learned how to reduce environmental threats to life, the presence of redundant physiological capacity permits them and the domesticated animals we protect to survive beyond the reproductive ages. Studies in lower animals that have led to the view that genes are involved in aging have demonstrated that significant declines in mortality rates and large increases in average and maximum life span can be achieved experimentally [82-85]. Without exception, however, these genes have never produced a reversal or arrest of the inexorable increase in mortality rate that is one important hallmark of aging. The apparent effects of such genes on aging therefore appear to be inadvertent consequences of changes in other stages of life, such as growth and development, rather than a modification of underlying aging processes. Indeed, the evolutionary arguments presented above suggest that a unitary programmed aging process is unlikely to even exist and that such studies are more accurately interpreted to have an effect on longevity determination, not the various biological processes that contribute to aging. From this perspective, longevity determination is under genetic control only indirectly [86,87]. Thus, aging is a product of evolutionary neglect, not evolutionary intent [88-91].

Can We Grow Younger?

Although it is possible to reduce the risk of aging-related diseases and to mask the signs of aging, it is not possible for individuals to grow younger. This would require reversing the degradation of molecular integrity that is one of the hallmarks of aging in both animate and inanimate objects. Other than performing the impossible feat of replacing all of the cells, tissues or organs in biological material as a means of circumventing aging processes, growing younger is a phenomenon that is currently not possible.

Genetic Engineering

After the publication of the human genome sequences, there have been assertions that this new knowledge will reveal genes whose manipulation may permit us to intervene directly in the processes of aging. Although it is likely that advances in molecular genetics will soon lead to effective treatments for inherited and age-related diseases, it is unlikely that scientists will be able to influence aging directly through genetic engineering [92,93]. because, as stated above, there are no genes directly responsible for the processes of aging. Centuries of selective breeding experience (in agricultural, domesticated and experimental plants and animals) has revealed that genetic manipulations designed to enhance one or only a few biological characteristics of an organism frequently have adverse consequences for health and vigor. As such, there is a very real danger that enhancing biological attributes associated with extended survival late in life might compromise biological properties important to growth and development early in life.

Replacing Body Parts

Suggestions have been made that the complete replacement of all body parts with more youthful components could increase longevity. Though possible in theory, it is highly improbable that this would ever become a practical strategy to extend length of life. Advances in cloning and embryonic stem cell technology may make the replacement of tissues and organs possible [94-99] and will likely have an important positive impact on public health in the future through the treatment of age-related diseases and disorders. But replacing and reprogramming the brain that defines who we are as individuals is, in our view, more the subject of science fiction than science fact.

Lifestyle Modification and Aging

Optimum lifestyles, including exercise and a balanced diet along with other proven methods for maintaining good health, contribute to increases in life expectancy by delaying or preventing the occurrence of age-related diseases. There is no scientific evidence, however, to support the claim that these practices increase longevity by modifying the processes of aging.

Concluding Remarks

Since recorded history individuals have been, and are continuing to be, victimized by promises of extended youth or increased longevity by using unproven methods that allegedly slow, stop or reverse aging. Our language on this matter must be unambiguous: there are no lifestyle changes, surgical procedures, vitamins, antioxidants, hormones or techniques of genetic engineering available today that have been demonstrated to influence the processes of aging [100,101]. We strongly urge the general public to avoid buying or using products or other interventions from anyone claiming that they will slow, stop or reverse aging. If people, on average, are going to live much longer than is currently possible, then it can only happen by adding decades of life to people who are already likely to live for 70 years or more. This "manufactured survival time" [102] will require modifications to all of the processes that contribute to aging--a technological feat that, though theoretically possible, has not yet been achieved. What medical science can tell us is that because aging and death are not programmed into our genes, health and fitness can be enhanced at any age, primarily through the avoidance of behaviors (such as smoking, excessive alcohol consumption, excessive exposure to sun, and obesity) that accelerate the expression of age-related diseases and by the adoption of behaviors (such as exercise and a healthy diet) that take advantage of a physiology that is inherently modifiable [103].

We enthusiastically support research in genetic engineering, stem cells, geriatric medicine and therapeutic pharmaceuticals, technologies that promise to revolutionize medicine as we know it. Most biogerontologists believe that our rapidly expanding scientific knowledge holds the promise that means may eventually be discovered to slow the rate of aging. If successful, these interventions are likely to postpone age-related diseases and disorders and extend the period of healthy life. Although the degree to which such interventions might extend length of life is uncertain, we believe this is the only way another quantum leap in life expectancy is even possible. Our concern is that when proponents of antiaging medicine claim that the fountain of youth has already been discovered, it negatively affects the credibility of serious scientific research efforts on aging. Because aging is the greatest risk factor for the leading causes of death and other age-related pathologies, more attention must be paid to the study of these universal underlying processes. Successful efforts to slow the rate of aging would have dramatic health benefits for the population by far exceeding the anticipated changes in health and length of life that would result from the complete elimination of heart disease, cancer, stroke and other age-associated diseases and disorders.

Authors and Endorsers

Dr. Olshansky is Senior Research Scientist and Professor at the School of Public Health, University of Illinois at Chicago. Dr. Hayflick is Professor of Anatomy at the University of California at San Francisco. Dr. Carnes is Assistant Professor of Geriatric Medicine at the University of Oklahoma. Drs. Olshansky and Carnes are also coauthors of The Quest for Immortality (Norton, 2001), a book-length antidote to anti-aging hype.

94.Stem Cells: Scientific Progress and Future Research Directions. Department of Health and Human Services. June 2001.

95.Stem Cells and the Future of Regenerative Medicine. Committee on the Biological and Biomedical Applications of Stem Cell Research, Board on Life Sciences National Research Council, Board on Neuroscience and Behavioral Health, Institute of Medicine. National Academy Press, 2002.

4. Testimonials and anecdotes are pervasive and are often times made up or paid for.

5. Some products work, they will say, because they are centuries old remedies.

6. Attempts to convey credibility are peppered throughout the literature or website with pictures of academic-looking people in white laboratory coats. "Certifications", "Colleges", "Academies" and "Institutes" are made up marketing tools of the industry.

7. Often, adverse reactions are not mentioned or are minimized and the claims sound too good to be true.

8. Simplistic rationales about why something works are frequent and are given to dupe the lay public. For example, growth hormone levels drop with age, therefore lower growth hormone levels cause aging.

9. They use celebrities in their advertising and testimonials.

10. They claim that they participate in “the esteemed medical tradition of off-label use”. In the case of growth hormone, such practice is illegal.

11. Products are sold. Practitioners who give advice where the incentive is to make money do not have your health and well being at the top of their priority list. This is an example of blatant conflict of interest in the medical community.

12. They provide misleading interpretations of studies or outright false claims that something works. The most common example of this for growth hormone is the citation of a New England Journal of Medicine article authored by Dan Rudman.

14. Money back guarantee are sometimes given. When the first purchase can involve hundreds of dollars, the proprietor can afford to not fulfill this promise.

15. They claim, “We are on your side”. By listing other products that don’t work or claiming that you deserve the freedom to choose, they attempt to appear to be your advocate. It is like having someone put their arm around you while lifting your wallet.

NEW YORK (MedscapeWire) Mar 04 — A fresh warning against the growing "hype" of so-called "anti-aging" medicine is being sounded by a blue-ribbon panel of experts on gerontology and medicine, after one of the most comprehensive reviews to date of the scientific evidence.

Although, the panel finds "much promise" in recent basic research on aging, it says the "anti-aging" movement threatens to discredit such serious "longevity" research and discourage investment in it by philanthropists, pharmaceutical companies, and government funders. Longevity research is vital as populations age, the panel says, because at the very least it could further reduce the diseases associated with aging. "The cost savings and health-related benefits to individuals and to our society in the near future would be tremendous."

The panel's review was organized by the International Longevity Center-USA (ILC-USA), a not-for-profit, nonpartisan policy research organization in New York City, with co-sponsorship by the Columbia University College of Physicians and Surgeons Center for the Study of Society and Medicine, the Kronos Longevity Research Institute, and the Canyon Ranch Health Resort. The co-chairs were the gerontologist Robert N. Butler, M.D., president of the ILC, and the bioethicist and historian David Rothman, Ph.D., of the Columbia College of Physicians and Surgeons. The panel's report is part of a growing effort by scientists to oppose "anti-aging" medicine and support more significant research.

The panel flatly states, "There is as yet no convincing evidence that administration of any specific compound, natural or artificial, can globally slow aging in people, or even in mice or rats." It links the "anti-aging" movement to a "long chain of quacks, snake-oil salesmen and charlatans."

Yet "anti-aging" medicine is a "multi-billion dollar industry in the U.S.," the ILC-USA report says. The industry "is under the control of non-scientists who use terms like 'virtual immortality' and 'an ageless society' to attract customers to untested remedies that have not withstood the rigors of serious clinical trials" and that often have dangerous adverse effects.

A further danger of "anti-aging" medicine, the panel says, is that it "promotes and reinforces ageism," putting a "profoundly negative connotation on the very occurrence of aging, emphasizing its negative and depleting aspects" and denying "all that is enriching and positive about aging in the psychosocial sphere."

Even without scientific breakthroughs, the panel estimates that people in industrialized countries could achieve "at least a ten-year increase" in average life expectancy by eating less and exercising more: "Half the [US] population is overweight, 20 percent is obese, and only 15 percent of people over the age of 65 regularly exercise. Our diets are overwhelmingly conducive to the development of coronary artery disease, and far too many of us still use tobacco products."

For the future, the report summarizes the encouraging but so-far equivocal results from work in restricted-calorie diets, genetic and chromosomal manipulation, and treatments with antioxidants, hormones like estrogen and growth hormone, and stem cells. It praises the National Institute on Aging's consideration of a comprehensive program for testing such possibilities.

The report -- "Is There An Anti-Aging Medicine?" - is available for free from the ILC-USA Web site at http://www.ilcusa.org. The scientific workshop it summarizes was the sixth in a series the ILC-USA has convened on critical and often unexplored issues in aging.

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